Brain death determination by angiography in the setting of a skull defect
L. A. Alvarez, R. B. Lipton, A. Hirschfeld, O. Salamon and G. Lantos
Department of Neurology, Bronx Municipal Hospital Center, Albert Einstein College of Medicine, New York.
The absence of cerebral blood flow is presently considered the most
reliable ancillary test in diagnosing brain death. A patient with an open
skull fracture who met all criteria for brain death, including confirmatory
postmortem studies, had a cerebral angiogram that showed unilateral
preservation of cerebral circulation with diffuse extravasation of contrast
material. We conclude that a skull defect may result in pressure reduction
within the cranial cavity and persistent ipsilateral cerebral circulation,
even after brain death. In this setting, diffuse extravasation of contrast
material on angiography may reflect diffuse autolysis and suggest the
diagnosis of brain death.